B型利钠肽联合TIMI危险积分对STEMI患者远期死亡风险预警价值的研究

A study on the value of B-type natriuretic peptide combines the TIMI risk score in predicting late mortality in patients with ST-segment elevation myocardial Infarction

目的:评价B型利钠肽(B-type natriuretic peptide,BNP)联合心肌梗塞溶栓(Thrombolysis in myocardial infarction,TIMI)危险积分对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者远期死亡率预警价值。方法:345例STEMI患者在首发胸痛24h内采血测定血浆BNP水平,并进行TIMI风险积分评定。对纳入病例进行长期随访,随访终点为全因性死亡,包括心血管病死亡和非心血管病死亡。结果:平均随访(314±208)d,死亡率为(69人)20.0%。远期死亡率与高TIMI积分密切相关(P<0.001)。血浆BNP水平升高与远期死亡率增加相关(中位数[全距]ng/L,存活者447.5[8～2854]vs死亡者986.0[31～4986],P<0.001)。多因素Cox分析表明,发病24h内血浆BNP水平升高和TIMI危险积分均为预测远期死亡风险升高的独立可靠指标(BNP,2.608[95%CI,1.840～3.696],P<0.001;TIMI危险积分,1.227[95%CI,1.138～1.323],P<0.001)。Kapian-Meier生存曲线分析结果为BNP低于中位数者较高于中位数者远期预后明显较佳(P<0.001)。远期生存曲线下面积(Area undera curve,AUC)BNP为0.797(P<0.001),而TlMI危险积分0.780(P<0.001),TIMI积分联合BNP可以提高预测死亡率的价值(AUC,0.853,P<0.001)。结论:发病24h内测定BNP水平和TIMI危险积分评定能可靠的预测STEMI患者远期死亡风险,BNP水平与TIMI危险积分两者联合能提高其预测远期死亡风险的价值。

Objective：Assessment ofthe value of B-type natriuretic peptide levels combines TIMI risk scores in predictinglate mortality in patients with ST-segment Elevation Myocardial Infarction（STEMI）.Methods：345 patients with STEMI were studied.Blood was drawn and the plasma concentration of BNP was determined within 24 hours after the onset of chest pain and the patients＇TIMI risk score was measured.The all-cause mortality,including cardiac and non-cardiac deaths during Long-term follow-up,was recorded.Results：Mortality was 20.0%（n=69）during a follow-up of 314±208 days.The late mortality was related to higher TIMI risk scores（P〈0.001）.Higher BNP levels were also related to increased late mortality（median（range）ng/L,survivors 447.5（8～2 854）vs dead 986.0（31～4 986）, P〈0.001）.In a multivariate Cox proportional hazards model,independent predictors of late mortality were BNP levels in the first 24 hours（BNP,2.608（95%CI,1.840～3.696）〉;P〈0.001）and TIMI risk scores（1.227（95%CI,1.138～1.323）,P〈0.001）.The Kaplan-Meier survival curve showed a significantly better clinical outcome in patients with BNP belowthe median than in those with BNP above the median（P〈0.001）.BNP yielded an area under the curve（AUC）of 0.797（P〈0.001）,for TIMI risk score the AUC was 0.780（P〈0.001）,for the AUC of combination of TIMI score and BNP was 0.853（P〈0.001）.Conclusion：In the first 24 hours following an STEMI,BNP and TIMI risk score can predict late mortality reliably.The combination of TIMI score and BNP can improve risk prediction for mortality.